TIME ebola

CDC: Cases of Ebola Could Double Every 20 Days

Members of a burial team wearing protective suits bury an Ebola victim in Freetown, Sierra Leone.
Members of a burial team wearing protective suits bury an Ebola victim at King Tom Cemetery, which is bitterly resented by residents of the adjoining slum, called Kolleh Town, in Freetown, Sierra Leone, Sept. 21, 2014. Samuel Aranda—The New York Times/Redux

A new CDC report predicts the enormous cost of delayed response to Ebola

If Ebola conditions continue without a scaled-up effort, the CDC estimates that cases of Ebola in West Africa will double every 20 days — and in an absolute worst-case scenario without any intervention, numbers could reach 1.4 million by Jan. 20.

Using a new Ebola Response prediction tool, the CDC has published results that show that if current trends continue unimpeded, Liberia and Sierra Leone will have approximately 8,000 total Ebola cases, or 21,000 if the tool accounts for underreporting, by Sept. 20. Liberia will account for about 6,000 of those cases.

The numbers are frighteningly high, but it should be noted that it’s a prediction of a hypothetical situation in which absolutely no intervention were to happen. That won’t be the case if many countries and the UN keep their promises. The model also shows that a big response could turn the outbreak around. In another hypothetical situation, the outbreak could ease up and eventually end if 70% of people with Ebola are placed in medical care facilities, Ebola treatment units, or somewhere where transmission could be contained.

“The model shows that a surge now can break the back of the epidemic,” said Dr. Tom Frieden, director of the CDC, in a press conference. “The importance of implementing effective programs rapidly cant be over-emphasized. The cautionary finding of the modeling is the enormous cost of delay.”

During the press conference, Dr. Frieden said the outbreak is very fluid and changing, but that he does not think West Africa will meet their worst case scenario predictions. “If you get enough people effectively isolated, the epidemic can be stopped…Even in dire scenarios, if we move fast enough we can turn it around. I do not think the most dire circumstances will come to pass,” he said.

The CDC report comes out on the same day the World Health Organization released their reports on the outbreaks at six months in all affected countries, and it appears that cases in Nigeria and Senegal have stabilized “for the moment.” Last week, President Obama announced a deployment of 3,000 U.S. military personnel and over $500 million in defense spending to go to West Africa, and the UN announced a new task force called the U.N. Mission for Ebola Emergency Response. The hope is that an exponentially increased response will prevent these possible scenarios.

TIME ebola

There Could Be 20,000 Ebola Cases by November if More Isn’t Done Now

Ebola Lessons
Nurses train to use Ebola protective gear with World Health Organization, WHO, workers, in Freetown, Sierra Leone on Sept. 18, 2014. Michael Duff—AP

Public-health experts warn that the epidemic could turn from “a disaster into a catastrophe”

A new study by the World Health Organization released on Tuesday warned of 20,000 Ebola cases worldwide in just over a month’s time if authorities failed to ramp up efforts to combat the growing epidemic.

“We estimate that, at the current rate of increase, assuming no changes in control efforts, the cumulative number of confirmed and probable cases by November 2 will be 5,740 in Guinea, 9,890 in Liberia, and 5,000 in Sierra Leone, exceeding 20,000 cases in total,” read the report published in the New England Journal of Medicine this week.

The Ebola virus is spread primarily through exposure to body fluids of symptomatic patients. Transmission of the virus is prevented through early diagnosis, contact tracing, patient isolation and infection control along with the safe burial of those killed by Ebola.

However, the virus has primarily hit impoverished West African communities, where many of these protocols are difficult or impossible to enforce.

“If we don’t stop the epidemic very soon, this is going to turn from a disaster into a catastrophe,” Christopher Dye, a co-author of the study and director of strategy at the WHO, told reporters in Geneva. “The fear is that Ebola will become more or less a permanent feature of the human population.”

The publication of the new report comes as Sierra Leone concluded an ambitious lockdown of the country for three days by effectively asking its 6 million residents to stay at home while approximately 30,000 volunteers and health officials canvassed the country to distribute soap and instructions on how to prevent contraction of the virus.

There are currently 5,833 recorded cases of Ebola across six African nations. The disease has killed at least 2,833 people.

TIME ebola

Ebola ‘Pretty Much Contained’ in Senegal and Nigeria

Christopher Dye, Director of Strategy of the World Health Organization speaks to the media about Ebola Virus Disease in West Africa, during a press conference, at the European headquarters of the United Nations in Geneva on Sept. 22, 2-14.
Christopher Dye, Director of Strategy of the World Health Organization speaks to the media about Ebola Virus Disease in West Africa, during a press conference, at the European headquarters of the United Nations in Geneva on Sept. 22, 2-14. Salvatore Di Nolfi—EPA

Good news for containment of an outbreak that has killed more than 2,800 people

The outbreaks of Ebola in Senegal and Nigeria have been “pretty much contained,” the World Health Organization said Monday.

There have been no new confirmed cases of Ebola in Senegal since the first case was reported Aug. 29, and the last case of Ebola reported in Nigeria was Sept. 8, the WHO’s regional office for Africa said in a statement. The news comes on the same day the WHO released details from the second meeting of the International Health Regulations Emergency Committee on Ebola. One of the top conclusions from the group was that travel and trade should continue in West Africa:

“Flight cancellations and other travel restrictions continue to isolate affected countries resulting in detrimental economic consequences, and hinder relief and response efforts risking further international spread,” the committee said.

The Committee reiterated WHO stances on making sure health care workers are protected from possible infections and ensuring people who are quarantined still have access to food and water.

There are currently 5,833 cases of Ebola in Sierra Leone, Liberia, Guinea, Senegal, Nigeria and the Democratic Republic of the Congo (though the DRC outbreak is thought to be unrelated to the others). Among those cases, 2,833 people have died.

 

TIME ebola

Timeline: The Worst Ebola Outbreak in History

As Ebola continues to ravage West Africa, follow this outbreak's most critical moments

TIME Nigeria

Supporters of Nigerian President’s Re-Election Bid Are Using a Terrible Hashtag

Nigeria's President Jonathan attends the Africa Union Peace and Security Council Summit on Terrorism at the KICC in Nairobi
Nigeria's President Goodluck Jonathan attends the Africa Union Peace and Security Council Summit on Terrorism at the Kenyatta International Convention Centre in Nairobi on Sept. 2, 2014 Thomas Mukoya—Reuters

A campaign hashtag derived from #BringBackOurGirls is doing the rounds even though the abducted schoolgirls remain missing

In an ill-advised political maneuver, supporters of Nigerian President Goodluck Jonathan have begun using the hashtag #BringBackGoodluck2015 to support the incumbent leader’s re-election bid.

The campaign is generating controversy because of its similarity to #BringBackOurGirls, one of the biggest social-media pushes of the year that was launched to demand the return of more than 200 Nigerian schoolgirls abducted in April by terrorist group Boko Haram. The al-Qaeda-affiliated jihadists have threatened to sell the girls as slaves.

What makes the repurposing of the hashtag even more unpalatable is that the victims have still not been rescued, despite a raft of promises by Jonathan’s government. The Nigerian military says it is reluctant to take concrete action lest Boko Haram kills the girls in response, reports the BBC.

Although #BringBackGoodluck2015 may not be officially used or endorsed by the President personally, it has appeared on banners and posters at several campaign events across the country. It also continues to do the rounds on Twitter, prompting widespread outrage.

A few users have spun the debate, though, by saying that it has, intentionally or not, reignited global conversation around the abducted schoolgirls.

But unwitting benefits aside, there appears to be little real defense for what the Washington Post says is likely “the most inappropriate political hashtag of the year.”

TIME Infectious Disease

Ebola Cases Spiking in West Africa As Death Toll Nears 2,300

People wait to be admitted into an Ebola treatment facility in Monrovia, Liberia, on Sept. 5, 2014.
People wait to be admitted into an Ebola treatment facility in Monrovia, Liberia, on Sept. 5, 2014. Daniel Berehulak—The New York Times/Redux

Guinea, Liberia and Sierra Leone together experienced a 49% increase in cases in just the last three weeks

Cases of Ebola in West Africa are continuing to rise exponentially, with Guinea, Liberia and Sierra Leone together experiencing a 49% increase in cases in just the last three weeks.

New data released Tuesday by the World Health Organization (WHO) shows that there are now a total of 4,269 cases in the three countries, including 2,288 deaths. Liberia alone has experienced a 68% increase in cases in the last three weeks. Localized clusters of Ebola have also been emerging in Nigeria and Senegal, where authorities have reported a combined total of 24 cases and eight deaths.

On Monday, the WHO released data on the troubling number of cases in Liberia, citing concerns that families riding in taxis or motorbikes to hospitals are spreading disease that way. Fourteen of Liberia’s 15 counties now have confirmed cases of the disease, and so far 152 health care workers have been infected, with 79 dying from the disease. The organization says it expects thousands of new cases in the next three weeks, and has called for all involved parties to at a minimum, triple their efforts.

Also on Tuesday, the U.S. Agency for International Development (USAID) announced that it is helping the African Union mobilize an additional 100 African health workers to help fight the outbreak with $10 million of funding. So far the U.S. has spent a reported $100 million responding to the outbreak.

The WHO has said that Liberia in particular needs better ideas for containing the disease. “Conventional Ebola control interventions are not having an adequate impact in Liberia, though they appear to be working elsewhere in areas of limited transmission, most notably in Nigeria, Senegal, and the Democratic Republic of Congo,” the WHO wrote in a recent update.

Dr. Kent Brantly, one of the American Ebola survivors who was infected in Liberia, agrees that regular methods aren’t working there. In an essay for TIME, Brantly wrote: “People are fearful of isolation units because “that is where you go to die.”…Perhaps we need to find a way to provide safe home care that protects the caregivers.”

Meanwhile in the U.S., Emory University Hospital received a third Ebola patient to its isolation unit on Tuesday morning. This is the fourth patient to be evacuated from West Africa to be treated with the disease in the U.S.

TIME Nigeria

US Air Marshal Attacked With Syringe

He was injected with an unknown substance

The FBI and CDC are investigating a person who allegedly attacked a federal air marshal, injecting him with a syringe of an unknown substance at the airport in Lagos, Nigeria on Sunday.

The air marshal, who was scheduled to board a United Airlines flight to Houston there, was given precautionary medications and flown with the rest of his teams and the syringe used in the attack back to the U.S., ABC News reports.

Upon his return to Houston, the marshal was put in quarantine due to concerns that the syringe may have contained the Ebola virus. Such an infection would not be immediately contagious.

[ABC News]

TIME Nigeria

As Boko Haram Strengthens, Terrified Locals Flee Major Nigerian City

Internally displaced persons, who are victims of Boko Haram attacks, stay at the IDP camp at Wurojuli
Internally displaced persons, who are victims of Boko Haram attacks, stay at the IDP camp for those fleeing violence from Boko Haram insurgents at Wurojuli, Gombe State Sept. 2, 2014. Reuters

Nigerian troops have floundered against the Islamist militants

Hundreds of people are believed to have fled the capital of Nigeria’s northeastern Borno state as Boko Haram militants continue to sweep unabated through the region and terrified locals doubt that the deflated Nigerian military will be able to protect them.

Nigerian officials are increasingly warning that the Islamist militant group might advance on Maiduguri, capital of the besieged state, and home to some 2 million people, the New York Times reports. Boko Haram, waging a barbarous campaign of violence, has over the summer quickly collected several municipalities in the northeast, some of which officials say could be used as bases from which the militants could close in on Maiduguri.

In an alarming harbinger earlier this week, Boko Haram fighters captured the town of Bama, about 45 miles from Maiduguri and a linchpin in the jihadists’ campaign to vanquish all of Borno. Government forces had rebuffed the militants during an initial siege on Monday, but the extremist group returned en masse the following day to overwhelm the town, according to Reuters.

A soldier who fought at Bama also told Reuters that government air reinforcements botched an air strike near the end of the battle, dropping bombs on parts of the town and killing everyone there — including insurgents, but also Nigerian troops.

Boko Haram fighters patrolling Bama have since prevented anyone from burying the dead, and bodies are rotting in its streets, the BBC reports. More than 26,000 people are believed to have fled the fallen town.

Meanwhile, a recent report from Chatham House, a London-based policy group, said the Nigerian army is failing, and will continue to fail, to battle back Boko Haram fighters, in large part because locals do not trust the national armed forces. Amnesty International has accused government troops of war crimes, including torturing suspected Boko Haram loyalists.

In late August, Boko Haram declared an Islamic caliphate in the land it has so far gathered up in northeast Nigeria, near the nation’s border with Cameroon. The group, dovetailing the Islamic State of Iraq and Greater Syria’s ominous promises for the towns and cities it has taken in the Middle East, has said the claimed territories will be ruled under strict Islamic law.

Hundreds of schoolgirls from Chibok, also in Borno, are still missing, almost five months after they were snatched by Boko Haram militants.

TIME Infectious Disease

Ebola Spreads to Southern Nigeria With 3 Cases Confirmed and 60 at ‘High Risk’

An aerial view of the oil hub city Port Harcourt in Nigeria's Delta region
An aerial view of the oil hub city Port Harcourt in Nigeria's Delta region May 16, 2012. Akintunde Akinleye / Reuters—REUTERS

WHO officials warn that the epidemic is accelerating rapidly

Correction appended, Sept. 4.

Three cases of Ebola have been identified in the southern Nigerian city of Port Harcourt, the World Health Organization (WHO) says, confirming that the disease has spread outside Lagos, where five people have died.

Officials in Port Harcourt — a teeming city of 1.4 million in the Niger delta — are now monitoring over 200 people, 60 of whom are considered at high risk of having contracted the disease. It is a worrying expansion of an epidemic that has now killed 1,900 in West Africa and defied the attempts of under-staffed and under-funded aid teams to halt it.

WHO officials warn that the virus is not just expanding geographically but also accelerating. Ebola has now sickened upwards of 3,500 people and in the past week alone almost 400 people have died of the virus, said Dr. Margaret Chan, director-general of the WHO at a press conference in Washington D.C. on Wednesday.

“This Ebola epidemic is the longest, the most severe and the most complex we’ve ever seen,” said Chan. Experts, she added, “have never seen anything like it.”

Some $600 million in supplies will now be needed to duel with the epidemic, the worst on record, WHO officials said—up $110 million from the estimate given last week, according to Reuters. The increased sum will further test the willingness of the global community to tackle the disease at source. Health organizations such as Doctors Without Borders have already been highly critical of what they say is a lackluster international response.

As the epidemic expands, resources on the ground have not, WHO officials said. There is no room in what few hospitals there are in the worst-hit areas; terrified medical staff have stopped showing up to work; and in Liberia the bodies of Ebola victims are being left unattended in the streets. Some who contract the disease are also choosing to hide their illness—in the meantime, unwittingly infecting those around them—rather than be turned upon by neighbors.

Meanwhile, some 150 scientists and experts convened Thursday at the WHO’s headquarters in Geneva, Switzerland, for a two-day meeting to review available experimental Ebola drugs and vaccines and draft testing plans for the most promising. None of the drugs have been tested in humans, but one of them, ZMapp, was given to two Ebola patients who survived their illness.

On Tuesday, the U.S. Department of Health and Human Services awarded a contract worth up to $42.3 million to ZMapp’s manufacturer, jump-starting clinical trials and fresh production of the drug, supplies of which are currently tapped out.

The W.H.O estimates that Ebola will take 20,000 more lives before its transmission is stopped.

Correction: The original version of this story incorrectly identified the capital of Nigeria. It is Abuja.

Footage of life in Dolo Town, some 40 miles (60 k.m.) east of Monrovia, Liberia, which has been quarantined to contain the spread of Ebola.

TIME Infectious Disease

How Nigeria Is Keeping Ebola at Bay

APTOPIX Nigeria Ebola
Nigeria health officials wait to screen passengers at the arrival hall of Murtala Muhammed International Airport in Lagos, Nigeria, Aug. 4, 2014. Sunday Alamba—AP

Fears that Africa's most populous country would become a tinderbox for the disease have so far not come to fruition

Ebola is still running rampant in parts of West Africa. Over 1,500 people have died in Guinea, Sierra Leone and Liberia, where authorities have risked unrest by imposing nationwide curfew and quarantine zones.

But in nearby Nigeria, the government has largely contained Ebola in a single cluster traced back to the first imported case, and reported a total of only six deaths. The death of a doctor in Port Harcourt, in the south of the country, initially raised fears of a second outbreak when it was revealed on Thursday—but it soon emerged that his infection was also linked to the first Ebola case.

Health experts say that while more Ebola cases can’t be ruled out, Nigerian authorities quickly and effectively reacted to contain the disease, tracking people who had contact with patients, conducting widespread testing and quarantining suspected victims. “The response of the government has been robust,” said John Vertefeuille, who leads the Nigeria Ebola response team of the U.S. Centers for Disease Control and Prevention (CDC).

Ebola arrived in Nigeria on July 20, when Liberian-American financial consultant Patrick Sawyer flew from Liberia to Lagos, Nigeria’s commercial capital. Sawyer collapsed at the airport and was taken immediately to hospital, reducing chances of infecting more people in Lagos, a city of more than 21 million people.

He infected a few people before he was isolated, as doctors didn’t initially suspect Ebola and didn’t take full precautions. All other confirmed cases were traced back to him; eight have recovered, with only one case still being treated in isolation.

When the government realized Ebola had arrived on Nigerian soil, it acted quickly to coordinate international health organizations including the CDC, the World Health Organization, and recently Médecins Sans Frontières. It invited those groups to “come to the table and… insert themselves into those structures that the government has formed,” said Vertefeuille.

The work is divided into the management of confirmed cases who are treated in an isolation center in Lagos, and epidemiology and contact tracing, key to containing the virus.

Confirmed cases are treated in isolation, while those the victims made contact with pre-diagnosis are visited daily at their homes. If they develop symptoms, they too are taken to quarantine and tested. Nigeria began its program of contact tracing with Sawyer, and currently has more than 100 people under surveillance in Lagos.

But one man slipped through the net, Health Minister Onyebuchi Chukwu said Thursday. A Nigerian man who had contact with Sawyer developed symptoms and evaded surveillance, traveling to the oil industry hub of Port Harcourt last month, where he was treated by a doctor for his symptoms.

The man recovered and returned to Lagos four days later, after a manhunt for him had begun. The doctor, however, had contracted the virus and died on Aug. 22. The government has now begun contact tracing for him, and 70 people are now under surveillance there.

The man who escaped surveillance was an isolated case, Chukwu said. The fact that most people being treated at hospital have survived and were soon discharged has encouraged people under surveillance to cooperate. “Initially when we started we had one or two stubborn cases, but now they’re all cooperating,” he said.

As well as taking a rapid response approach to Ebola cases, the government has also been acting to stop the spread of misinformation about the disease. It has been issuing bulletins explaining how the disease spreads, and attempting to dispel rumors about unorthodox “cures” that have spread on the streets and on social media.

Benjamin Akinola, a 65-year-old retired army officer, said he and his wife bathed with and drank water with salt after a rumor suggested it could prevent Ebola. They stopped after hearing on the radio that it led to the death of some people. “People stopped it, and this is what the government is telling us,” said Akinola.

The government has also been pushing for better personal hygiene practice. Guards at supermarkets, banks, restaurants, and clubs will often spray people’s hands with sanitizers before entering.

The public relations operation seems to be working. Lawrence Obioha, a 43 year old newspaper seller in Lagos said initially fewer people attended his Sunday church service out of fear of Ebola. “Gradually it’s picking up,” he said. “There’s a lot of relief now that they know that at least there’s a response to treatment.”

While fears that Africa’s most populous country would become a breeding ground for the disease have so far proven unfounded, officials in Nigeria are under no illusion that the virus has been stamped out. “We have not eliminated the disease. We have not eradicated it,” said Chukwu. Over 200 remain under observation, and the infection is still raging in Sierra Leone, Guinea and Liberia. The battle against Ebola will continue in Nigeria for some time yet.

“This really could be a long and a hard fight,” said David Daigle, a spokesman for the CDC team on Ebola in Nigeria. “We’re optimistic, but we know that this is like a forest fire and if there’s just one ember left in place it could easily start back up.”

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